99 DOTS- Envelopes

The 99DOTS product consists of customised envelopes (see Figure 1) that fit around the tuberculosis medication blister pack distributed to persons on TB treatment. 

Figure 1: 99DOTS Envelope

Universal Envelopes (Figure 2): Each adult patient gets the same sleeve, regardless of their weight band.

These are new envelopes that are currently being introduced by the program. Weight band wise envelopes will be used while the stock lasts, but new requirements by the state will be fulfilled by providing universal envelopes.

There are 2 types of these envelopes: 1 envelope for IP: Intensive Phase, and 1 envelope for CP: Continuation Phase, for both Macleods and Lupin Fixed-dose Combinations (FDCs). These envelopes are only to be used for adult persons on treatment on anti-TB treatment using FDCs.

Figure 3: Universal 99DOTS Envelopes

Using the Universal Envelope

• The counsellor/ pharmacist/ treatment supporter write the number of pills per day the patient should take on the envelope.
• Every day, the person on treatment will take the prescribed number of pills and reveal 1, 2, or 3 hidden phone numbers. The patient calls any one of the numbers they reveal that day.
• The patient should start at pill 1 and move in sequence (1,2,3…28), completing each column, and starting from the top of each row.
• The district should always have sufficient stock, which can be calculated as:
  • Number of IP strips = Number of IP envelopes + some buffer
  • Number of CP strips = Number of CP envelopes + some buffer

Advantages of the Universal Envelopes

• There is no need to estimate the requirements of weight band wise envelopes.
• Less space is required to store the envelopes.
• Stock-outs of envelopes for a particular weight band will not occur.
• It is easy for persons on treatment to follow the top to down arrow mark pattern while dispensing and ingesting medicines.
• Counselling time and dispensing time by pharmacists reduce per patient, thus increasing efficiency.

Resources:

• Nikshay 99DOTS Training Manual, 2021.
• Nikshay 99DOTS Universal Envelope Training Manual, 2021.
• 99 DOTS Website.

Assessment